Disaster drill prepares Israel for a mass casualty event

A sudden explosion on a university campus in southern Israel seemed to take everyone by surprise. When the smoke lifted, the sight of dozens of bodies lying on the ground, many of them bloodied, came as something of a shock — even though the crowd gathered on the makeshift stands had come that morning for the purpose of observing an elaborate emergency drill staged by Israeli authorities.

This time, the drill was designed to test the country’s ability to handle a non-conventional attack, in this case a “toxicological mass casualty event,” deployed with stunning realism with the participation of a large number of Israeli agencies, with professionals playing the precise roles they would carry out in a real emergency, and a number of Israeli soldiers acting in the role of victims of the attack, complete with bloody wounds and all manner of distress.

The drill was held to coincide with the conclusion of this year’s IPRED meeting, a gathering of experts in preparedness and response for emergencies and disasters. Some 200 participants from more than 30 countries — many from China and the United States — attended.

The simulated explosion on Jan. 13 at Ben Gurion University, in the city of Beersheba, unleashed a frenzy of choreographed activity, which allowed Israelis to calibrate their plans for events others may view as far-fetched but Israel sees as worthy of thorough preparation requiring a considerable investment of time and scarce resources.

Moments after the explosion, a first responder walked on the scene. Contacting his dispatchers he reported mass casualties, and immediately started coughing and choking. Before collapsing he conveyed basic information, enough for the dispatcher to communicate suspicions that a chemical agent was at play. It might be terrorism or an accident. At this stage it was not known. Gradually, the sound of emergency sirens started filling the air and a panoply of teams in hazmat suits and other forms of personal protection equipment entered the scene.

Responders made first-hand observation of the victims’ symptoms — tearing, salivation, etc. — reaching a preliminary determination that the toxic substance was an “organophosphate.” With that, victims immediately received antidote injections and nearby Soroka Medical Center activated its protocol for mass casualty toxicological events. The simulation involved some 300 direct casualties. A secondary explosion escalated tensions but did not seem to disrupt activities. Firefighters contained the flames, and hazmat teams cleaned a toxic spill, while the site of the original blast was sealed and the substance taken for analysis.

It was later confirmed to have been Sarin gas released by the blast, clearly a (simulated) terrorist attack. Sarin was used in 1995 by a terrorist group in Tokyo, and is suspected to have been use by the Syrian government against civilians.

Not far from the disaster zone, a small city of mobile command posts came to life. Vehicles housing high-tech equipment to coordinate teams from the police, firefighers, health authorities, the military’s Homefront Command, as well as the Magen David Adom, which is Israel’s version of the Red Cross, responsible for ambulance services and other first responder functions for the entire country.

At the hospital, decontamination facilities were set up outside the emergency room and in minutes ambulances started arriving. Triage happened outside, near the ER entrance. Inside, teams donning respirators and personal protection equipment started treating victims. Mental health experts treated those in shock, and even the Social Work department activated special mass casualty protocols.

Perhaps the most important part of the drill, as with all such exercises in Israel, comes after the exercise ends. The critical “lessons learned” post-mortem tells authorities, agencies and hospitals what they did wrong. What could go wrong, and what needs to change.

A now-retired top level U.S. public health official told me the U.S. conducts more “tabletop” drills, rather than the highly elaborate ones Israelis see every few months. But nothing prepares better, and nothing provides the level of confidence gleaned from a large scale civil defense exercise.

Israelis, better than possibly people of any other country on earth, understand the importance and the benefits of strong civil defense practices. Nationwide drills involving civilians — much larger than the one in Beersheba — are conducted regularly. They are one of the reasons why Israeli casualty counts have remained relatively low in recent wars, despite thousands of rockets launched by Hamas and by Hezbollah. Some of those rockets, incidentally, have fallen in Beersheba, not far from Soroka Hospital.

Israelis hope they will never see Sarin nerve gas terrorism, or any other non-conventional attack. But there was a startling seriousness in this drill. Yes, this was a simulation, but everyone knew that mass casualty events are happening all too often in real life.